| NPI | 1033943196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC3466) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACll200001267) |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2026-08-18 |