| NPI | 1053279828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: TX 1446) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: TX 20725) |
| Enumeration Date | 2026-01-12 |
| Last Update Date | 2026-07-04 |