| NPI | 1144061649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation (Licence: AZ 23683875) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2026-01-30 |