| NPI | 1609419951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA 10139) |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2024-05-20 |