| NPI | 1114817954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO LSW.0009925225) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ADDC.0000448) |
| 1041C0700X Social Worker, Clinical (Licence: CO SWC.0000001756) | |
| Enumeration Date | 2025-07-03 |
| Last Update Date | 2025-07-23 |