| NPI | 1366013039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: NC HC6102) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC HC6102) |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child (Licence: NC HC6102) | |
| Enumeration Date | 2021-07-05 |
| Last Update Date | 2021-07-22 |