| NPI | 1598061988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2023-10-12 |