| NPI | 1760980536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACII1218) |
| 101YP2500X Counselor, Professional (Licence: DC LGPC00321) | |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2022-04-19 |