| NPI | 1720865199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 0) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2025-08-18 |