| NPI | 1295282275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA 046) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2018-09-27 |