| NPI | 1609238096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: LA 8864631) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2025-12-02 |