| NPI | 1275363772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002697) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO LSW.0009924618) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-02-26 |