| NPI | 1568608420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TX 14557506) |
| Enumeration Date | 2008-12-26 |
| Last Update Date | 2008-12-26 |