| NPI | 1356778989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0012921) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0007003) |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2022-07-21 |