| NPI | 1184302200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 385HR2050X Respite Care, Respite Care Camp |
| 251E00000X Home Health | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2024-01-24 |