| NPI | 1720269566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA A7580745) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2022-11-29 |