| NPI | 1093248155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CGIXPARSWVJQMTOF) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA Caade) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2023-06-07 |