| NPI | 1720900020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 372600000X Adult Companion |
| 347C00000X Private Vehicle | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| 251B00000X Case Management | |
| 376J00000X Homemaker | |
| 385H00000X Respite Care | |
| Enumeration Date | 2026-07-28 |
| Last Update Date | 2026-07-30 |