| NPI | 1124871652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200005509) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: DC PT100004369) |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2025-09-22 |