| NPI | 1154897635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA14057) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2024-05-10 |