| NPI | 1598424624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 172V00000X Community Health Worker (Licence: SD CHW500) | |
| 174H00000X Health Educator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2023-11-04 |