| NPI | 1639976186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: NE 73608402) |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: NE 73608402) |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child (Licence: NE 73608402) | |
| Enumeration Date | 2025-03-03 |
| Last Update Date | 2025-03-03 |