| NPI | 1881233690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 251S00000X | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2020-11-03 |