| NPI | 1801327895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 85989) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: CA 85989) | |
| 172V00000X Community Health Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2018-12-07 |