| NPI | 1639770639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM 1077) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-09 |