| NPI | 1427783232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA R1475550722) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2023-05-11 |