| 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 |