| NPI | 1366929259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child |
| 385HR2050X Respite Care, Respite Care Camp | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 251E00000X Home Health | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2018-07-24 |