| NPI | 1710682299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW122858) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2025-05-14 |