| NPI | 1104595651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002264) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2024-01-04 |