| NPI | 1194520171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY NYCPS-P-52209) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2025-02-14 |