| NPI | 1043029531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 372500000X Chore Provider |
| 372600000X Adult Companion | |
| 373H00000X Day Training/Habilitation Specialist | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2024-12-30 |