NPI | 1457844649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926662) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001089) |
101YM0800X Counselor, Mental Health (Licence: CO CSW.09926662) | |
Enumeration Date | 2018-06-12 |
Last Update Date | 2024-10-10 |