| NPI | 1417775065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002414) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPCC.0021797) |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2024-10-02 |