| NPI | 1720594260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6851116595) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2023-06-14 |