Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1194275644 |
---|---|
Provider Name | Zumar Dubose |
First Address | Philadelphia, PA 19150-2110 |
Second Address | Philadelphia, PA 19150-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2016 |
Last Update Date | 08/10/2016 |