| NPI | 1699075085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: FL ACN570) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: PR 18065) |
| 172V00000X Community Health Worker (Licence: FL ACN-570) | |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2022-07-21 |