| NPI | 1194192245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: PA TEI004216) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CO PTA.0013570) |
| 172V00000X Community Health Worker (Licence: UT 9406205-2404) | |
| 172V00000X Community Health Worker (Licence: OR 09204) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2015-08-25 |