| NPI | 1104719954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant (Licence: AK 1712359) |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2026-03-02 |