| NPI | 1518954643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3874) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 5782) |
| 101YM0800X Counselor, Mental Health (Licence: CO 2955) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2016-04-18 |