| NPI | 1609136423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA8908) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: DC 62407) |
| Enumeration Date | 2012-05-26 |
| Last Update Date | 2016-11-29 |