| NPI | 1033702634 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2024-11-13 |