| NPI | 1265904635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 116233) |
| Additional Taxonomies | 104100000X Social Worker |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2023-03-14 |