| NPI | 1730412396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 174H00000X Health Educator | |
| 183700000X Pharmacy Technician (Licence: TX 102114) | |
| 183700000X Pharmacy Technician (Licence: 260101030750018) | |
| 305S00000X Point of Service | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2021-12-13 |