Individual
NSOH CHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8162 WASHINGTON BLVD, JESSUP, MD 20794-8813
(949) 533-1501
Mailing address
8162 WASHINGTON BLVD, JESSUP, MD 20794-8813
(949) 533-1501
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
374U00000X
Home Health Aide
Primary
—
DC
Other
Enumeration date
08/07/2024
Last updated
11/19/2024
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