| NPI | 1639712409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2024-09-17 |