| NPI | 1922893858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200004873) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MD A00216596) |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2026-05-14 |