NPI | 1609337906 |
---|---|
Other Name | TIMOTHY WAYNE CASTRO CROY |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB.0008498) |
Enumeration Date | 2019-03-28 |
Last Update Date | 2019-03-28 |