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 |