| NPI | 1386383479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator (Licence: TX 13530) |
| Additional Taxonomies | 251B00000X Case Management |
| 171400000X Health & Wellness Coach | |
| 172V00000X Community Health Worker (Licence: TX 13530) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2025-09-17 |