| NPI | 1154142701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200004187) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-11-08 |