| NPI | 1306543913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: OH G8JjZOBdWB) |
| Additional Taxonomies | 172A00000X Driver (Licence: OH VK495627) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-02-14 |