| NPI | 1629327069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 251E00000X Home Health | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2024-01-15 |