| NPI | 1508543398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0023689) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002962) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0021090) | |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2026-05-19 |