| NPI | 1740775808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA13633) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2023-10-25 |