NPI | 1962966432 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 28769) |
Additional Taxonomies | 101YP2500X Counselor, Professional |
172V00000X Community Health Worker | |
Enumeration Date | 2019-01-29 |
Last Update Date | 2024-06-18 |