| NPI | 1114301884 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: MI CPSS) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MI CPSS) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2015-07-13 |