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 |