| NPI | 1326854118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 261QC1500X Clinic/Center, Community Health | |
| 175T00000X Peer Specialist | |
| 251S00000X Community/Behavioral Health | |
| 251B00000X Case Management | |
| Enumeration Date | 2024-12-05 |
| Last Update Date | 2026-02-27 |