| NPI | 1366165060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 101Y00000X Counselor |
| 103K00000X Behavior Analyst | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 172A00000X Driver | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 372500000X Chore Provider | |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2022-09-19 |