| NPI | 1215505094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 251X00000X | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2024-08-26 |