| NPI | 1265138184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200002712) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MD CNA20224389) |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2023-05-18 |