| NPI | 1154839199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925226) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000905) |
| 101YM0800X Counselor, Mental Health (Licence: CO LSW.0009920980) | |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2024-01-05 |