| NPI | 1720070147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PR 7428) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: PR 7428) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2017-02-22 |