| NPI | 1346024536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: AZ CHW0000000856) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2026-03-24 |