| NPI | 1629717822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 11446) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2024-10-28 |