| NPI | 1881276723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2025-08-21 |