| NPI | 1902591431 |
|---|---|
| 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 | 2023-04-10 |
| Last Update Date | 2026-04-17 |