| NPI | 1154675569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 1130) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2025-05-08 |