| NPI | 1275362576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM CPSW1765) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2025-12-30 |