| NPI | 1922619493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2023-05-11 |