| NPI | 1588257646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2025-09-09 |