NPI | 1104408939 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 172V00000X Community Health Worker |
Additional Taxonomies | 106S00000X Behavior Technician |
175T00000X Peer Specialist | |
Enumeration Date | 2021-04-21 |
Last Update Date | 2024-11-04 |