| NPI | 1730653254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 12267033-3502) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: UT 884) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2021-07-20 |