| NPI | 1588011449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 690882996) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2025-01-03 |