| NPI | 1376420893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002799) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0023303) |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-08-27 |