| NPI | 1619428638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA12346) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2023-10-25 |