| NPI | 1184132243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA13349) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: DC RBT-22-223275) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2022-07-27 |