| NPI | 1811476112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2019-05-08 |