| NPI | 1124843859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: MD PR0937) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MD 01914-24-A) |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2024-11-22 |