| NPI | 1649997636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 11866128) |
| Additional Taxonomies | 253J00000X Foster Care Agency (Licence: AZ 11866128) |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ 11866128) | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2023-04-24 |