| NPI | 1639244114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 133) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: AK 133) |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: AK 133) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2010-06-10 |