| NPI | 1336882554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2022-04-15 |
| Last Update Date | 2024-12-13 |