NPI | 1679051692 |
---|---|
Former Name | KYLIE TAMIKO GUMBAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor |
Additional Taxonomies | 172V00000X Community Health Worker |
Enumeration Date | 2018-08-01 |
Last Update Date | 2021-03-29 |