| NPI | 1922518430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 172V00000X Community Health Worker | |
| 174H00000X Health Educator | |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2017-10-10 |