| NPI | 1639906167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |