| NPI | 1952900029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA BGJCTOWPNUFIHRLA) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2023-03-17 |