| NPI | 1083074116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2023-06-22 |