| NPI | 1902384977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 139899) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 118510) |
| 172V00000X Community Health Worker | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2026-07-14 |