| NPI | 1679334775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 385H00000X Respite Care | |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-03-29 |