| NPI | 1427646439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA OMZWNJPKTQHLEIVS) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2024-10-30 |