| NPI | 1346939543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 110208) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 246Y00000X Spec/Tech, Health Info | |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-12-21 |