| NPI | 1538890264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 385H00000X Respite Care |
| 251300000X Local Education Agency (LEA) | |
| 251B00000X Case Management | |
| 253Z00000X In Home Supportive Care | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2022-06-22 |