| NPI | 1639915903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: MD PR0966) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: PR0966) |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2024-07-05 |