| NPI | 1104669100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 385HR2050X Respite Care Respite Care Camp |
| 385HR2055X Respite Care Respite Care, Mental Illness, Child | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-08-02 |