| NPI | 1912781360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA200003807) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2024-07-02 |