| NPI | 1487297511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD0002279) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2023-11-14 |