| NPI | 1689172785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA13419) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2023-07-11 |