| NPI | 1164030763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0021111) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACA.0007946) |
| 146N00000X Emergency Medical Technician, Basic (Licence: CO 007371) | |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2022-01-11 |