| NPI | 1700534617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY CRPA-P-5821) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY 5821) |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-03-10 |