| NPI | 1750197521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM 1997) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NM CCSS) |
| Enumeration Date | 2024-12-06 |
| Last Update Date | 2025-12-26 |