| NPI | 1518585983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 174H00000X Health Educator |
| 225400000X Rehabilitation Practitioner | |
| 251K00000X Public Health or Welfare | |
| Enumeration Date | 2020-07-11 |
| Last Update Date | 2020-07-11 |