| NPI | 1285003590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |