| NPI | 1194471409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: MN 1112834) |
| Additional Taxonomies | 253J00000X Foster Care Agency (Licence: MN 1113281) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-10-25 |