| NPI | 1407003312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA S1104291427) |
| 101Y00000X Counselor | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2023-10-16 |