| NPI | 1053861930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CP5030) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2021-11-17 |