| NPI | 1962149070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 16958) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2024-07-18 |