NPI | 1487026571 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: NY 28854) |
Enumeration Date | 2015-10-28 |
Last Update Date | 2015-10-28 |