| 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 |