| NPI | 1538531066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB.0007937) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929651) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2023-12-11 |