| NPI | 1538985049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: NV CHW2-5096) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NV PRSS-5160) |
| 175T00000X Peer Specialist (Licence: NV PRSS-SUP-5142) | |
| Enumeration Date | 2024-11-29 |
| Last Update Date | 2025-08-21 |