| NPI | 1366187890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200003342) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2024-11-20 |