| NPI | 1265918999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 374700000X Technician | |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2023-08-21 |