| NPI | 1184904385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 61941) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2021-02-10 |