| NPI | 1922153915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2024-02-21 |