| NPI | 1992373286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN200002341) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2024-06-21 |