| NPI | 1467221192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME XL7816) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2025-01-26 |