| NPI | 1912598541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 16381) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 12477) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2024-04-25 |