| NPI | 1659136026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA R1544990124) |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: CA R1544990124) |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2024-02-15 |