| NPI | 1447640958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: AZ 957399) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ 957399) |
| 104100000X Social Worker (Licence: AZ 957399) | |
| 171M00000X Case Manager/Care Coordinator (Licence: AZ 957399) | |
| 174H00000X Health Educator (Licence: AZ 957399) | |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2019-07-16 |