| NPI | 1497279897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2022-07-21 |