| NPI | 1316490188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09923531) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000536) |
| 1041S0200X Social Worker, School (Licence: CO 187071) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2016-07-28 |