| NPI | 1598310351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 174H00000X Health Educator | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2019-08-07 |