| NPI | 1679827364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 372600000X Adult Companion |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2025-09-04 |