| NPI | 1912478454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| 347E00000X Transportation Broker | |
| 251300000X Local Education Agency (LEA) | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 251S00000X | |
| 251X00000X | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2018-12-12 |