| NPI | 1093342412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO SWC.0000001468) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACD.0002422) |
| 172A00000X Driver | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-03-06 |