| NPI | 1114101763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 104185) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2023-06-07 |