| NPI | 1376811539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: AK 08-982-P) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2025-01-27 |