NPI | 1053604959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA HWCXSDVBJMQNYRAT) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2011-05-25 |
Last Update Date | 2023-03-16 |