| NPI | 1053822775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 104100000X Social Worker |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2019-07-24 |