| NPI | 1477258853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD MD-10272361905) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2023-05-04 |