| NPI | 1285516096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NE CPSS-428) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE CPSS-428) |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-10-21 |