| NPI | 1629880646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child |
| Additional Taxonomies | 372500000X Chore Provider |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2025-01-25 |
| Last Update Date | 2025-01-25 |