NPI | 1972735462 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 172V00000X Community Health Worker |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
175T00000X Peer Specialist | |
Enumeration Date | 2009-08-17 |
Last Update Date | 2023-06-30 |