NPI | 1730710302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 172V00000X) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2020-01-31 |
Last Update Date | 2023-06-05 |