| NPI | 1043484306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: FL 385HR2060X) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |