| NPI | 1023377694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CACII200001262) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2024-09-04 |