| NPI | 1023739273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY NYCPS-P4548) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY CRPA-5254) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |