| NPI | 1659030914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 246Y00000X Specialist/Technologist, Health Information |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2022-01-25 |