| NPI | 1235006404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: UT F25-118953) |
| Enumeration Date | 2025-10-21 |
| Last Update Date | 2025-11-03 |