| NPI | 1790500130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200004568) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 376K00000X Nurse's Aide (Licence: MD A00222813) | |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2025-02-14 |