| NPI | 1417428327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPCC.0021992) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACA.0008337) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO60571715) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2024-05-09 |