| NPI | 1619543337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY CRPA-P-5164) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-11-18 |