| NPI | 1790343275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA Ci41131223) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 171M00000X Case Manager/Care Coordinator | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1255520617) | |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-02-05 |