| NPI | 1669035564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1375130120) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2023-06-01 |