| NPI | 1417674573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 376G00000X Nursing Home Administrator | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |