| NPI | 1922581859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 06152) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2024-07-22 |