| NPI | 1073087722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: UT F22-102569) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2024-10-17 |