| NPI | 1164897567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: AZ BH4758) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: AZ BH-4758) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2024-05-09 |