| NPI | 1922923291 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NM LPN-22147) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2026-08-13 |
| Last Update Date | 2026-08-13 |