| NPI | 1063187268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200002172) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MD A00178622) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2024-02-28 |