| NPI | 1245922822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA14179) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2025-10-23 |