| NPI | 1376126623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200001449) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MD A00193764) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-07-08 |