| NPI | 1649537028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L15145) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 16044) |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist (Licence: TX 205-0124) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2024-04-23 |