NPI | 1477095123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171W00000X Contractor |
Additional Taxonomies | 172A00000X Driver |
372600000X Adult Companion | |
390200000X Student in an Organized Health Care Education/Training Program | |
172V00000X Community Health Worker | |
Enumeration Date | 2016-11-12 |
Last Update Date | 2017-05-04 |