| NPI | 1679171144 |
|---|---|
| Former Name | DERRICK L ALLEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant (Licence: WV 1568796027) |
| 376J00000X Homemaker (Licence: WV 1568796027) | |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2021-12-14 |