| NPI | 1124426242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: PR 19154) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: PR 13614) |
| Enumeration Date | 2014-12-06 |
| Last Update Date | 2015-09-30 |