| NPI | 1932980976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 172A00000X Driver | |
| 172V00000X Community Health Worker | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |