| NPI | 1023854718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care Respite Care, Mental Retardation and/or Developmental Disabilities (Licence: AZ LCR-219669-13781) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2024-07-02 |