| NPI | 1528360864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW14016) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: FL CCHW100151) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2022-07-21 |