| NPI | 1962808865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B00002281221) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2023-06-02 |