| NPI | 1568234391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: LA OBHSS874) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA OBHPSS874) |
| Enumeration Date | 2023-10-25 |
| Last Update Date | 2023-10-25 |