| NPI | 1508258302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB 7020) |
| 101YM0800X Counselor, Mental Health (Licence: CO 09923464) | |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2022-09-15 |