| NPI | 1235006313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2025-10-22 |