NPI | 1992025803 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 172V00000X Community Health Worker (Licence: FL 691097196) |
Additional Taxonomies | 172V00000X Community Health Worker (Licence: FL 691097198) |
Enumeration Date | 2010-06-03 |
Last Update Date | 2010-06-03 |