| NPI | 1063206217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR THW000111369) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 111369) |
| Enumeration Date | 2025-04-04 |
| Last Update Date | 2025-04-04 |