| NPI | 1679283634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NV PRSS-5030) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NV CHW2-5022) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2022-11-30 |