| NPI | 1730928250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 373H00000X Day Training/Habilitation Specialist | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2024-05-23 |