| NPI | 1417352584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO NLC 0103118) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACA 0006988) | |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2014-10-31 |