NPI | 1629839469 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
171M00000X Case Manager/Care Coordinator | |
Enumeration Date | 2024-01-18 |
Last Update Date | 2024-10-09 |