| NPI | 1114582343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2023-10-30 |