| NPI | 1881575702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: NC M2025-14513-01) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC M2025-14513-01) |
| 101YM0800X Counselor, Mental Health (Licence: NC M2025-14513-01) | |
| Enumeration Date | 2025-09-09 |
| Last Update Date | 2025-09-09 |