| NPI | 1932302858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: MN 16809) |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: MN 16809) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2025-09-11 |