| NPI | 1952542706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA B9627256) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2009-03-07 |
| Last Update Date | 2014-03-14 |