NPI | 1124883301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA F3637480) |
Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA F3637480) |
Enumeration Date | 2024-02-16 |
Last Update Date | 2024-09-12 |