| NPI | 1750787263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: MD m250751019101) |
| Additional Taxonomies | 102X00000X Poetry Therapist |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2014-11-10 |