| NPI | 1780734459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 6020871735) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 6020871735) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2023-05-23 |