| NPI | 1295583813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 247200000X Technician, Other | |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2026-02-23 |