| NPI | 1376035238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2023-08-18 |