| NPI | 1730871039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2023-09-14 |