| NPI | 1396481883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 14011805-3503) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2024-06-20 |