| NPI | 1730995911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: VT S92) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: VT S95) |
| 175T00000X Peer Specialist (Licence: VT S93) | |
| 175T00000X Peer Specialist (Licence: VT S94) | |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2024-12-03 |