| NPI | 1376897264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 10013) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 10013) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2018-04-06 |