| NPI | 1821583170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B001320420) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2025-01-10 |