| NPI | 1023262730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: DC 039844200) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: DC 03984420) |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: DC 039844200) | |
| 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: 039844200) | |
| 237700000X Hearing Instrument Specialist (Licence: DC 039844200) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: DC 039844200) | |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: DC 039844200) | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2008-11-07 |