| NPI | 1740841667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2023-06-01 |