| NPI | 1508322942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA13104) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2024-09-20 |