| NPI | 1093554925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM 1635) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NM 00000) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2024-05-21 |