| NPI | 1639624646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1333270119) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2020-06-15 |