| NPI | 1720539976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1009105) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA11903) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2024-04-30 |