| NPI | 1598528853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: UT F24-111180) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2025-03-25 |