| NPI | 1679873897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: UT 139432-3501) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2010-10-22 |