| NPI | 1063986586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2021-07-21 |