| NPI | 1750864229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OR 17-CRM-207) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000002406) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2020-07-23 |