| NPI | 1164379079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 253Z00000X In Home Supportive Care | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2026-03-11 |
| Last Update Date | 2026-03-11 |