| NPI | 1902711542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 342000000X Transportation Network Company |
| 106S00000X Behavior Technician | |
| 251S00000X Community/Behavioral Health | |
| 3747P1801X Technician, Personal Care Attendant | |
| 172V00000X Community Health Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| 172A00000X Driver | |
| Enumeration Date | 2026-08-18 |
| Last Update Date | 2026-08-25 |