| NPI | 1932053873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: AZ D09261199) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: AZ D09261199) |
| Enumeration Date | 2026-02-26 |
| Last Update Date | 2026-03-23 |