| NPI | 1750538179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services (Licence: RI 00037) |
| Additional Taxonomies | 104100000X Social Worker (Licence: RI 00037) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2008-08-27 |