| NPI | 1376721902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: WI 172V00000X) |
| Additional Taxonomies | 177F00000X Lodging (Licence: WI 177F00000X) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2008-02-06 |