| NPI | 1780383083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171W00000X Contractor |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2023-07-25 |