| NPI | 1780431981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator (Licence: NV 5232) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NV 5096) |
| Enumeration Date | 2024-05-04 |
| Last Update Date | 2024-05-04 |