| NPI | 1912658238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: LA obhpss856) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA NA) |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2022-05-31 |