| NPI | 1922866367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: UT f25-127234) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 14292996-6006) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2026-07-27 |