| NPI | 1134135718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 273R00000X Psychiatric Unit |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-09-04 |