| NPI | 1003231622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2022-02-11 |