| NPI | 1245574375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 11954344-3501) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2023-02-01 |