| NPI | 1215659941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO SWC.0000000528) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ADDC.0000160) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2022-09-19 |