| NPI | 1952152514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: NM G-1774) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: AZ CHW0000000656) |
| 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician (Licence: NM 32D2133123) | |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2025-10-14 |