| NPI | 1952009953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC LGPC200001633) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACII1310) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2024-02-16 |