| NPI | 1003621939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services (Licence: NE H13240518) |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: NE H13240518) | |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-03-08 |