| NPI | 1417379074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-24 |