| NPI | 1740815497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: AZ 10195508) |
| Additional Taxonomies | 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ 10195508) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-03 |