| NPI | 1912475278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA14112) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2023-07-05 |