| NPI | 1295334480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator (Licence: NY LA1457148) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NY LA1457148) |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |