| NPI | 1467031294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002665) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO ACD.0002665) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-04-25 |