| NPI | 1477181006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 88317) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-11-06 |