| NPI | 1962081539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 174400000X Specialist |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-03-21 |