| NPI | 1003315730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT 097.0136720) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 104100000X Social Worker (Licence: VT 156.0134408) | |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2026-02-26 |