| NPI | 1699543892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 261QA0600X Clinic/Center Adult Day Care | |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |