| NPI | 1285435313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist (Licence: NC 29251460801) | |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-10-16 |