| NPI | 1194154849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: NV 46-2608838) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV 46-2608838) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2013-11-04 |