| NPI | 1912549957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HA14723) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2023-06-13 |