| 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 |