NPI | 1124655329 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0022255) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002437) |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2020-03-26 |
Last Update Date | 2025-06-04 |