| NPI | 1356932081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OK 132116) |
| Additional Taxonomies | 374K00000X |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2025-01-16 |