| NPI | 1366844839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD0000714) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO NLC.0104025) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2016-10-11 |