| NPI | 1962966432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 287698) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2025-12-03 |