| NPI | 1083276190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 253Z00000X In Home Supportive Care | |
| 376J00000X Homemaker | |
| 385H00000X Respite Care | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2019-06-28 |