| NPI | 1003458571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 251S00000X |
| 374U00000X Home Health Aide (Licence: DC HHA14670) | |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2023-07-20 |