| NPI | 1104621952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-05-02 |