| NPI | 1306772934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2026-06-22 |
| Last Update Date | 2026-06-23 |