| NPI | 1821583402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OK 20902) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OK 130888) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2025-12-29 |