| NPI | 1568831824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB.0008255) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO NLC.0105138) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2018-05-07 |