| NPI | 1023650744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA14687) |
| Additional Taxonomies | 251E00000X Home Health (Licence: DC HHA14687) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-14 |