| NPI | 1043696800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 385HR2050X Respite Care, Respite Care Camp |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |