| NPI | 1548839103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO CSW.09929354) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2023-06-20 |