| NPI | 1003177486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1056134) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MD N-225-074-244-577) |
| 374U00000X Home Health Aide (Licence: DC HHA4945) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2023-08-17 |