| NPI | 1447133566 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACII200001270) | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC 200001270) | 
| Enumeration Date | 2025-07-28 | 
| Last Update Date | 2025-07-28 |