NPI | 1265121057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09931200) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002575) |
Enumeration Date | 2023-05-05 |
Last Update Date | 2024-12-19 |