| NPI | 1124639661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor | |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2026-04-16 |