| NPI | 1629841143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |