| NPI | 1346021300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002670) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0023058) |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2025-08-14 |