| NPI | 1255116471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MO 2023034713) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MO 2020033222) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |