| NPI | 1689412843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: MD 0629) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: MD 0629) |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2024-07-19 |