| NPI | 1770056608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R8764) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2023-08-18 |