| NPI | 1548804305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2023-03-02 |