| NPI | 1134975543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: UT 2023038607) |
| 172A00000X Driver | |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2024-04-26 |