| NPI | 1083034797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: MI 410357) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 410357) |
| 171W00000X Contractor (Licence: MI 410357) | |
| 172A00000X Driver (Licence: MI 410357) | |
| 174H00000X Health Educator (Licence: MI 410357) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2014-04-21 |