NPI | 1629643598 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
172V00000X Community Health Worker | |
Enumeration Date | 2021-05-24 |
Last Update Date | 2021-05-24 |