| NPI | 1013124957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC MHL-069-006) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: NC MHL-069-006) |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MH069-006) | |
| 385H00000X Respite Care (Licence: NC MHL-069-006) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-09-11 |