NPI | 1104225754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2014-08-20 |
Last Update Date | 2014-08-20 |