| NPI | 1538669171 |
|---|---|
| Other Name | JACK THOMAS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO NLC.0108047) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-02-20 |