| NPI | 1497635015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200005342) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2026-03-18 |