| NPI | 1548782584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: TX 2404) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2022-07-21 |