| NPI | 1972199339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 130640) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2025-07-25 |