| NPI | 1952061152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2026-08-25 |