| NPI | 1306962923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 227) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2018-01-15 |