| NPI | 1871249045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ADDC.0000392) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO ADDC.0000392) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2022-02-26 |
| Last Update Date | 2023-08-21 |