NPI | 1457187320 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251S00000X Community/Behavioral Health |
Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
Enumeration Date | 2024-09-09 |
Last Update Date | 2025-09-03 |