| NPI | 1740823921 |
|---|---|
| Former Name | EDISON JULIAN MANFOSTE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2025-06-12 |