| NPI | 1861290207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2025-03-03 |
| Last Update Date | 2025-10-17 |