| NPI | 1861066953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| 251C00000X Day Training, Developmentally Disabled Services | |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2021-05-13 |