| NPI | 1134948011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 251B00000X Case Management |
| 171M00000X Case Manager/Care Coordinator | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2025-11-17 |