| NPI | 1689525263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 374700000X Technician | |
| Enumeration Date | 2026-02-09 |
| Last Update Date | 2026-02-09 |