| NPI | 1750964995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200001782) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: DC NA0000608931) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2025-12-03 |