| NPI | 1861214785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker | |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2025-09-26 |