| NPI | 1013511120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 251S00000X | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2022-03-24 |