| NPI | 1790496438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 7283) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2024-06-17 |