| NPI | 1902681521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: DC 172V00000X) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MD 172V00000X) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2025-02-11 |