| NPI | 1235635434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2018-04-05 |