| NPI | 1669097432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 247200000X Technician, Other | |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-05-16 |