| NPI | 1578097424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-06-05 |