| NPI | 1598742777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2002032260) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: MO 2002032260) |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 2002032260) | |
| 385H00000X Respite Care (Licence: MO 2002032260) | |
| 3747P1801X Technician, Personal Care Attendant (Licence: MO 2002032260) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2008-08-26 |