| NPI | 1174104491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 172A00000X Driver |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2021-04-19 |