| NPI | 1033411798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW-360) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACC-6523) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2014-06-03 |