| NPI | 1467384560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: VT 193.0000005) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2026-06-02 |
| Last Update Date | 2026-06-02 |