NPI | 1205646700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0021717) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ADDC.0000364) |
Enumeration Date | 2025-01-08 |
Last Update Date | 2025-01-08 |