| NPI | 1952792087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: UT 17) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |