| NPI | 1366217986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| Enumeration Date | 2023-11-24 |
| Last Update Date | 2023-11-24 |