| NPI | 1740435155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: CT HCA.0000322) |
| Additional Taxonomies | 172A00000X Driver (Licence: CT HCA.0000322) |
| 172V00000X Community Health Worker (Licence: CT HCA.0000322) | |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2009-12-24 |