| NPI | 1326355090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171100000X Acupuncturist (Licence: CO 1527) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2017-07-27 |