| NPI | 1992680276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: RI 2218047) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-08-07 |
| Last Update Date | 2025-08-07 |