| NPI | 1225741374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 172A00000X Driver | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 372600000X Adult Companion | |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-04 |