| NPI | 1235856162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002096) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009924378) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-21 |