| NPI | 1851178933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 121773) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2024-05-14 |