| NPI | 1821665647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200001491) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MD A00180485) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2025-10-16 |