| NPI | 1205360849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO CSW.00001783) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: CO 103TC1900X) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2018-01-16 |