| NPI | 1932957867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 247200000X Technician, Other |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-06-20 |