| NPI | 1154173839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: TN 1000000034299) |
| Additional Taxonomies | 347E00000X Transportation Broker (Licence: TN 1000000034299) |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2024-04-16 |