| NPI | 1285760827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0066955) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO 9923571) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 316) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2023-07-26 |