| NPI | 1508658451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2025-05-19 |