| NPI | 1972328631 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OR 930841022) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 930841022) |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2024-11-18 |