| NPI | 1174760441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0001662) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0004616) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2019-05-06 |