| NPI | 1366804791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA D8406174) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2023-06-20 |