| NPI | 1023404563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1198020415) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA I7460559728) | |
| Enumeration Date | 2015-04-11 |
| Last Update Date | 2023-02-24 |