| NPI | 1750905808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OK 1750905808) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2021-06-07 |