| NPI | 1528566171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: FL 153143) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: FL W153143) |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2018-06-16 |