| NPI | 1366216038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care Respite Care, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 3747P1801X Technician Personal Care Attendant |
| 172A00000X Driver | |
| 376J00000X Homemaker | |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-13 |