| NPI | 1821817172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider |
| Enumeration Date | 2024-10-04 |
| Last Update Date | 2024-10-04 |