| NPI | 1487007688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist (Licence: NM R30018) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: NM R30018) |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2016-07-22 |