| NPI | 1417433376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: AZ 222697) |
| Additional Taxonomies | 385HR2055X Respite Care Respite Care, Mental Illness, Child (Licence: AZ 222697) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2023-05-05 |