| NPI | 1184150369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA12741) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: DC NA0000810600) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2017-05-05 |