| NPI | 1811358864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NC 2018-5019-01) |
| Additional Taxonomies | 172A00000X Driver |
| 372500000X Chore Provider (Licence: NC 430176) | |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2019-06-11 |