| NPI | 1811488661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA13677) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care (Licence: DC HHA13677) |
| 376K00000X Nurse's Aide (Licence: DC HHA13677) | |
| Enumeration Date | 2018-05-27 |
| Last Update Date | 2018-06-16 |