| NPI | 1891484218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: VA 2477) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2023-05-02 |