NPI | 1497464853 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1454361221) |
172V00000X Community Health Worker | |
324500000X Substance Abuse Rehabilitation Facility (Licence: CA R1454361221) | |
Enumeration Date | 2022-11-15 |
Last Update Date | 2024-09-18 |