NPI | 1558904557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist (Licence: TX 1271-0621) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: TX 50028-0820) |
Enumeration Date | 2019-10-22 |
Last Update Date | 2024-01-28 |