| NPI | 1023566023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-10-07 |