| NPI | 1053003285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200002860) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2024-06-24 |