| NPI | 1760297295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM 1934) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2026-04-10 |