| NPI | 1326470378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2025-01-15 |