| NPI | 1649520529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1005610) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2024-02-27 |