| NPI | 1780748954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency |
| Additional Taxonomies | 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ 11551) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-08-27 |