| NPI | 1780269167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1422280321) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2023-03-22 |