| NPI | 1497539811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci27730719) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2024-04-19 |