| NPI | 1033530670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: DC 605752) |
| 374U00000X Home Health Aide (Licence: DC HHA10212) | |
| Enumeration Date | 2013-12-29 |
| Last Update Date | 2023-05-22 |