NPI | 1972075612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-HBLASF) |
Additional Taxonomies | 172V00000X Community Health Worker |
Enumeration Date | 2018-12-19 |
Last Update Date | 2024-11-13 |