| 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 |