| NPI | 1508531419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN500020674) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2025-11-20 |