| NPI | 1891484101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: DC 251B00000X) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-07-05 |