| NPI | 1750417457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 174400000X Specialist | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2024-03-07 |