| NPI | 1144924234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: UT FPSS-01430) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: UT CPSS-01611) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |