| NPI | 1780555235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NM 1929) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: Ccss) |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2025-12-29 |