| NPI | 1639572068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: VA 2599) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |