| NPI | 1699924753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services (Licence: NY 1260712) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2008-09-14 |
| Last Update Date | 2008-10-12 |