| NPI | 1568684587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: NC 9600596) |
| Additional Taxonomies | 207ZB0001X Pathology Blood Banking & Transfusion Medicine (Licence: SC 8538) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2018-03-17 |