| NPI | 1902420425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker | |
| 172A00000X Driver | |
| 174400000X Specialist | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2020-06-01 |