| NPI | 1013700939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: UT F25-119630) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: UT 0) |
| Enumeration Date | 2025-05-23 |
| Last Update Date | 2025-07-10 |