| NPI | 1811021009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A8558906) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2024-02-13 |