| NPI | 1366940579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 2110806-I) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2024-06-04 |