| NPI | 1174351217 |
|---|---|
| Former Name | MICHAEL ELMORE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17100-131) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-07-22 |