| NPI | 1134815152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2023-10-18 |