| NPI | 1922483932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC4938) |
| 101Y00000X Counselor (Licence: CA 4938) | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2024-04-02 |