| NPI | 1093673451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200005998) |
| Additional Taxonomies | 251E00000X Home Health |
| 376K00000X Nurse's Aide | |
| 172V00000X Community Health Worker | |
| 251S00000X Community/Behavioral Health | |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2026-01-14 |
| Last Update Date | 2026-03-05 |