| NPI | 1336975499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200004281) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MD A00221199) |
| Enumeration Date | 2024-09-13 |
| Last Update Date | 2025-02-28 |