| NPI | 1205170115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA2983) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: DC 92283) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2014-04-01 |