| NPI | 1699806075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA None2) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2023-06-15 |