NPI | 1962874826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 172V00000X Community Health Worker |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 3003) |
101YM0800X Counselor, Mental Health (Licence: CA 3003) | |
Enumeration Date | 2015-10-30 |
Last Update Date | 2023-06-22 |