| NPI | 1821893926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 253J00000X Foster Care Agency |
| Enumeration Date | 2025-02-13 |
| Last Update Date | 2025-02-14 |