| NPI | 1528790557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPCC.0018247) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0997934) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-06-28 |