NPI | 1982133120 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 174400000X Specialist |
251V00000X Voluntary or Charitable | |
374K00000X | |
Enumeration Date | 2017-06-10 |
Last Update Date | 2017-06-10 |