| NPI | 1770166019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2025-08-11 |