| NPI | 1134769680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 373H00000X Day Training/Habilitation Specialist | |
| 171R00000X Interpreter | |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2025-04-14 |