| NPI | 1164214151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174200000X Meals (Licence: GA 25097941) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: GA 25097941) |
| 251S00000X Community/Behavioral Health (Licence: GA 25097941) | |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2025-05-19 |