| NPI | 1356937429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY CRPA-4379) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY NYCPS-P-3794) |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2020-12-14 |