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 |