| NPI | 1235883547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 171M00000X Case Manager/Care Coordinator | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| Enumeration Date | 2022-02-06 |
| Last Update Date | 2022-02-06 |