| NPI | 1144990730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2026-06-10 |