| NPI | 1184167165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2016-11-23 |