| NPI | 1265895668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1008727) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA11923) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2019-01-15 |