| NPI | 1710391149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 175T00000X Peer Specialist (Licence: NCPS-200076) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2025-09-08 |