| NPI | 1801956990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency |
| Additional Taxonomies | 174400000X Specialist |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-02-08 |