| NPI | 1063299774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: UT F23-109820) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2024-01-25 |