| NPI | 1750927075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 247200000X Technician, Other | |
| 374700000X Technician | |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2020-10-12 |