| NPI | 1093948689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: N/A) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2023-07-31 |