| NPI | 1629354600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NC A00001102) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2011-10-23 |
| Last Update Date | 2013-09-03 |