| NPI | 1477301695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 1477301695) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-07-16 |