| NPI | 1477434470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-08 |