| NPI | 1174343172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251X00000X Supports Brokerage | |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2024-10-14 |