NPI | 1376095091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 172V00000X Community Health Worker |
Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: OR 16-05-10) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-05-10) | |
Enumeration Date | 2016-10-28 |
Last Update Date | 2023-04-14 |