| NPI | 1295625184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services (Licence: NE NA) |
| Additional Taxonomies | 372500000X Chore Provider (Licence: NE NA) |
| 373H00000X Day Training/Habilitation Specialist (Licence: NE NA) | |
| 374U00000X Home Health Aide (Licence: NE NA) | |
| Enumeration Date | 2025-07-03 |
| Last Update Date | 2025-07-03 |