NPI | 1669246674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
Additional Taxonomies | 251S00000X |
261QD1600X Clinic/Center, Developmental Disabilities | |
261QM0850X Clinic/Center, Adult Mental Health | |
Enumeration Date | 2023-11-09 |
Last Update Date | 2023-11-09 |