| NPI | 1821544511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA12302) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-03-13 |