| NPI | 1629165097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: AZ 4698) |
| Additional Taxonomies | 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ 4698) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2021-05-03 |