| NPI | 1093306078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172A00000X Driver | |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2024-04-01 |