| NPI | 1043796683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: UT F23-103545) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2026-04-15 |