| NPI | 1629722871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002703) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0022850) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2025-03-04 |