| NPI | 1063178440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM 1241) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CTL0223091) |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2022-02-23 |