| NPI | 1942895859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: OR 117116) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 26-CRM-5724) |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2026-09-14 |