| NPI | 1033148572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000718) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO NLC0104740) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO NLC0104740) | |
| 101YM0800X Counselor, Mental Health (Licence: CO NLC0104740) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-03-16 |