| NPI | 1417657644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY 6648) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 36106) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2025-06-20 |