NPI | 1164794202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 172V00000X Community Health Worker (Licence: OR 18101) |
Additional Taxonomies | 171W00000X Contractor (Licence: OR 18101) |
Enumeration Date | 2012-02-06 |
Last Update Date | 2012-02-06 |