| NPI | 1558462481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO LAC 127) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW 434) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149010487) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |