| NPI | 1073902805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| 385H00000X Respite Care | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2015-01-16 |