| NPI | 1053683730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1007660) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2018-06-25 |