NPI | 1790031227 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
Enumeration Date | 2012-08-02 |
Last Update Date | 2020-06-17 |