| NPI | 1568296341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 131135) |
| 172V00000X Community Health Worker | |
| 104100000X Social Worker (Licence: CA 131135) | |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2026-01-16 |