| NPI | 1194062737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA6019) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2018-07-11 |