| NPI | 1689395873 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT F25-117252) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: UT 1783) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2025-05-12 |