| NPI | 1578011920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: FL 11-1158-GH) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-09-14 |