| NPI | 1154613438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO LCSW 985090) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO C.A.C. III 1548) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2011-05-05 |