| NPI | 1770070864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA13606) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2025-09-17 |