| NPI | 1336758630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OR THW000003999) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2024-03-21 |