Individual
ASU LIKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 FORT MEADE RD APT 708, LAUREL, MD 20707-4428
(443) 518-0162
Mailing address
200 FORT MEADE RD APT 708, LAUREL, MD 20707-4428
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA14624
DC
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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