| NPI | 1164964102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA12461) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2023-06-15 |