| NPI | 1508492190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MD HHA15034) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2025-02-19 |