| NPI | 1568516433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACII1110) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DC NAT1000043) |
| 101Y00000X Counselor (Licence: MD AC0045) | |
| 101Y00000X Counselor (Licence: MD CACII1110) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2024-06-28 |