| NPI | 1013488618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA B001230819) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA B001230819) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B001230819) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci21340119) | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA B001230819) | |
| Enumeration Date | 2018-12-08 |
| Last Update Date | 2024-11-21 |