| NPI | 1518606474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO SWC.0000001295) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2024-10-26 |