NPI | 1417266370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225400000X Rehabilitation Practitioner |
Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
Enumeration Date | 2010-09-27 |
Last Update Date | 2012-12-11 |