| NPI | 1578056214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P016726) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2026-06-23 |