| NPI | 1699117861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA Aii053600318) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2023-07-05 |