| NPI | 1831698232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 174400000X Specialist | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2018-03-22 |