| NPI | 1386279321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID 33493) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: ID 0) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-06-02 |