| NPI | 1386965176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0020787) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2018-07-17 |