| NPI | 1447411939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-096-028) |
| Additional Taxonomies | 251E00000X Home Health |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2021-10-27 |