| NPI | 1679341697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NM 11302023) |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2025-07-24 |