| NPI | 1982764999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: CA 108911) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-08-13 |