| NPI | 1528892619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2025-10-07 |