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 |