| NPI | 1922452028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA12091) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: DC NA00607833) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2018-11-13 |