| NPI | 1275866881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |