| NPI | 1013390905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-07-09 |