NPI | 1801683438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WI 0019817) |
Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: WI 0019817) |
103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
Enumeration Date | 2025-04-24 |
Last Update Date | 2025-04-24 |