| NPI | 1659579639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: TX 246) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX 246) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2020-03-16 |