| NPI | 1174879035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C4026) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2020-09-25 |