| NPI | 1477391878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OR 93-0841022) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 93-0841022) |
| Enumeration Date | 2024-07-18 |
| Last Update Date | 2024-07-18 |