| NPI | 1649743576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701011311) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACII1369) |
| 101YP2500X Counselor, Professional (Licence: DC PRC15137) | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2024-05-06 |