| NPI | 1811786890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: UT 1311) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: UT F24-110428) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-05-05 |