| NPI | 1629609482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 101YP2500X) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 101YP2500X) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2025-05-09 |