| NPI | 1093543811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2025-03-26 |