| NPI | 1396505970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 104100000X Social Worker | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-03-21 |