NPI | 1649522061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA VWDAUJYTBKEQFZSP) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
175T00000X Peer Specialist | |
Enumeration Date | 2012-10-09 |
Last Update Date | 2023-03-06 |