| NPI | 1326774183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 1326774183) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2025-02-03 |