| NPI | 1003230095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 3747A0650X Technician, Attendant Care Provider | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2014-02-11 |