| NPI | 1174262828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO addc.0000227) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO lpcc.0019659) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2023-06-28 |