| NPI | 1790250678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA C036660116) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C036660116) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2023-07-05 |