| NPI | 1386491298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 311Z00000X Custodial Care Facility | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 342000000X Transportation Network Company | |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-04-30 |