| NPI | 1194090985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV LP0109) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD #226) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 0390-LC) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC #6108) | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2017-06-04 |