| NPI | 1902581390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2025-11-18 |