| NPI | 1801140207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: AZ 1747326) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ 1747326) | |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2021-02-03 |