| NPI | 1811363476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: AZ 3832292) |
| Additional Taxonomies | 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ 3832292) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2025-06-23 |