| NPI | 1821448390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: TN 000-1180) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: TN L000000017975) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2019-12-18 |