| NPI | 1134803265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: AZ SLH10671) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: AZ SLH10671) |
| 253J00000X Foster Care Agency (Licence: AZ SLH10671) | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2024-02-28 |