| NPI | 1235796921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 287351) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-08-22 |