NPI | 1659015733 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 172V00000X Community Health Worker |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
Enumeration Date | 2022-04-25 |
Last Update Date | 2023-09-25 |