NPI | 1275317133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AK 101559) |
Enumeration Date | 2023-08-22 |
Last Update Date | 2023-08-22 |