| NPI | 1760218952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: TX QMHP) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2025-03-08 |