| NPI | 1417507203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: DC RN1049231) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACII200001312) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2026-06-16 |