| NPI | 1306612403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: GA 0000) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: GA 0001) |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2023-11-29 |