| NPI | 1942044870 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 172V00000X Community Health Worker | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: UT F24-116019) | 
| Enumeration Date | 2024-06-25 | 
| Last Update Date | 2025-07-15 |