| NPI | 1962094870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200002141) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2026-01-05 |