| NPI | 1679906069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA9425) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 374U00000X Home Health Aide (Licence: DC 4517) | |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2016-09-08 |