| NPI | 1467218172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR A182443) |
| Additional Taxonomies | 261QR0800X Clinic/Center, Recovery Care (Licence: OR A182443) |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |