| NPI | 1023637345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: AZ 10125986) |
| Additional Taxonomies | 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ 10125986) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2020-09-11 |