| NPI | 1386297075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA APC000387) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2024-10-24 |