| NPI | 1669638201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2008-09-25 |