| NPI | 1396089769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1004269) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: DC CPTH12 73) |
| Enumeration Date | 2012-11-24 |
| Last Update Date | 2026-01-16 |