| NPI | 1467907956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1049957) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA12276) |
| 374U00000X Home Health Aide (Licence: DC 374U00000X-HHA) | |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2019-09-18 |