| NPI | 1750853651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-00832) |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2021-04-12 |