| NPI | 1861125817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 140902) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 1041C0700X Social Worker, Clinical | |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2026-08-12 |