| NPI | 1609564871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2025-05-08 |