| NPI | 1952181844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2024-08-27 |