| NPI | 1508440090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC HHA15740) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-09-03 |