NPI | 1962870519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
172V00000X Community Health Worker | |
Enumeration Date | 2015-09-11 |
Last Update Date | 2016-12-15 |