| NPI | 1306712815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NV PRSS-5296) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-21 |