| NPI | 1609233238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: R1235741116) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2023-12-20 |