| NPI | 1679118863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2020-11-06 |