| NPI | 1811327687 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 3208) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2018-07-12 |