| NPI | 1821971326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2025-07-30 |