| NPI | 1093606816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM 1368) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2026-0750) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2026-08-31 |