NPI | 1871897223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: CA 01-098740) |
Enumeration Date | 2010-12-28 |
Last Update Date | 2015-07-14 |