| NPI | 1871291138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: IA 120966) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA t23015) |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-12-07 |