| NPI | 1760230981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 24-CCHW-00011) |
| Additional Taxonomies | 251S00000X (Licence: CA 24-CCHW-00011) |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A063000723) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-12-16 |