| NPI | 1174084347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-08-26 |