| NPI | 1811769490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: WA CG61497980) |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2025-08-04 |