| NPI | 1578040192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0018241) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ACD.0001849) |
| 101YM0800X Counselor Mental Health (Licence: CO MFTC.0013817) | |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2022-05-18 |