| NPI | 1245837566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 171W00000X Contractor |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-09 |