| NPI | 1285490011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-02-28 |