| NPI | 1316863707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: OR 116780) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 116780) |
| Enumeration Date | 2026-06-29 |
| Last Update Date | 2026-06-29 |