| NPI | 1477430486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Enumeration Date | 2025-08-20 |
| Last Update Date | 2025-08-20 |