| NPI | 1578246419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2023-08-08 |