| NPI | 1881016400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: DC PRC111054) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: DC 111054) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |