| NPI | 1649685710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB.0008092) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO boulder county publi) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2017-07-28 |