| NPI | 1689866790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: WY 112738100) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2007-08-13 |