| NPI | 1821464462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 1910559) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2021-03-26 |