| NPI | 1649051624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NC 2024-11487-01) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 405300000X Prevention Professional (Licence: NC 1649051624) | |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2024-03-08 |