| NPI | 1710787239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC 200005836) |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2025-12-11 |