| NPI | 1912225004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: SC 20-4692852) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: SC 3692) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2010-05-13 |