| NPI | 1275653370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: TX 100477) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2007-07-08 |