| NPI | 1215660279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 172v00000x) | |
| 101Y00000X Counselor | |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2025-02-06 |