| NPI | 1558048710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NJ 28RW03568700) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2026-02-04 |