| NPI | 1750130290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 24-CRM-3267) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 114706) |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2026-02-10 |