NPI | 1003320748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA GTICZBVPYRFLJQXS) |
Additional Taxonomies | 172V00000X Community Health Worker |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2017-11-16 |
Last Update Date | 2023-06-28 |