| NPI | 1477371144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 167G00000X Licensed Psychiatric Technician | |
| 273R00000X Psychiatric Unit | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2025-04-25 |