| NPI | 1245503622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A020100815) |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2024-03-03 |