| NPI | 1780414151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-06 |