| NPI | 1134588924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |