| NPI | 1467102285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 23347) |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: MA 0422RC) |
| 171M00000X Case Manager/Care Coordinator | |
| 172A00000X Driver (Licence: MA S17673016) | |
| 172V00000X Community Health Worker | |
| 174H00000X Health Educator | |
| 175T00000X Peer Specialist (Licence: MA 202052) | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2024-07-25 |