NPI | 1144846544 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 172V00000X Community Health Worker |
251S00000X Community/Behavioral Health | |
Enumeration Date | 2020-06-22 |
Last Update Date | 2020-06-22 |