| NPI | 1932976867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 20-CRM-045) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OR 20-CRM-045) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2024-02-09 |