| NPI | 1548221187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.00992708) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0997700) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-08-14 |