| NPI | 1033325485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH20433) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: FL 1164581633) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-12-11 |