| NPI | 1154856631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA 72019) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2025-04-22 |