| NPI | 1437413002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0012699) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000479) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2022-09-23 |