| NPI | 1467048470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: OH 5005902) |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2020-12-14 |