| NPI | 1992581243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: MA 16015886) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: FL A650818993360) |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-09-04 |