| NPI | 1396638896 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-06-12 |