| NPI | 1972749463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4737) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CO 4737) |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2011-01-11 |