| NPI | 1801459417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144309) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2024-01-11 |