| NPI | 1083090609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: NV Chw1-6167) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP1600X Counselor, Pastoral (Licence: CA 26-0-086-469) | |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2025-08-14 |