NPI | 1497587802 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
Enumeration Date | 2024-08-14 |
Last Update Date | 2024-08-14 |