| NPI | 1487232542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0003056) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009927396) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-09-16 |