| NPI | 1205405867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200002849) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant (Licence: MD MT0103132) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2023-07-05 |