| NPI | 1154042190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 405300000X Prevention Professional (Licence: NJ P00662) | |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-09-08 |