| NPI | 1629919949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: ND 46546) |
| Additional Taxonomies | 251B00000X Case Management |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2026-04-02 |
| Last Update Date | 2026-04-02 |