| NPI | 1386011492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 24925) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2023-01-17 |