| NPI | 1912386319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RS8311A) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2024-04-10 |