| NPI | 1043811524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO LSW.0009923159) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACA.0007628) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-03 |