| NPI | 1538520325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 21187) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: PR 14037) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2022-06-15 |