| NPI | 1417299884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0011620) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0011620) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000477) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2014-09-11 |