| NPI | 1578269098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: MA 0550) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: MA 202321) |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2026-05-26 |