| NPI | 1497226385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC CAC11019) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC 1019) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2024-09-09 |