| NPI | 1285299669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA iftraglvekcsnxob) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2023-08-01 |