| NPI | 1144737362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 179638) |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: CA 179638) | |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2024-06-04 |