| NPI | 1205082294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2025-05-02 |