| NPI | 1780294694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 390200000X) | |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2024-03-19 |