| NPI | 1447755079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002389) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0016260) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-02-09 |