| NPI | 1063903219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251S00000X | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2021-04-19 |