| NPI | 1114081809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MN L0542186) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2025-03-07 |