| NPI | 1912413220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1009066) |
| Additional Taxonomies | 251E00000X Home Health (Licence: DC HHA13006) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2025-11-21 |