| NPI | 1174949192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO LSW.0009921950) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001121) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2023-09-14 |